Summary
Overview
Work History
Education
Skills
Additional Information
Languages
Will be working Remotely from India
Timeline
Generic

Namratha Gillala

East Walpole,MA

Summary

Professional Project Management Specialist with experience working with teams to accomplish short- and long-term project goals. Managed budgets and monitored project costs.

Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.

Knowledgeable Systems Analyst with history of progressive leadership and project management, including gathering requirements, developing user cases, and delivering key initiatives.

Align teams and drive collaboration and cohesion to complete projects on time and within budget.

Subject Matter Expertise - Claims processing, PBM, ICD 9/10, Medicare, or Medicaid, EDI Transactions such as 270/271, 276/277, 278, 834, 837 & 835 Successful background maintaining efficient systems by leveraging infrastructure and operational knowledge to enhance processes.

Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.

Positive and calm professional skilled at analyzing qualitative and quantitative information and translating into strategic deliverables.

Thorough Quality Assurance Manager creates successful quality assurance strategies and processes. Accomplished at identifying deficiencies and initiating solutions to problems.

Overview

16
16
years of professional experience

Work History

EDI PM Advisor

Gainwell Technologies
11.2022 - 04.2023
  • Lead large project teams by breaking down bigger technological programs and assisting with project staffing.
  • Spearheaded project planning, tracking and oversight of assigned staff by providing direction and deadlines to ensure quality and timely completion of tasks
  • Communicated with client, company and project team leadership, measuring and sharing project metrics/status; recommend program changes as needed
  • Created project schedules, program definitions, budgets and objectives to ensure quality of project deliverables across all phases
  • Actively project managed across non-direct reports by quickly escalating any risks and implementing risk mitigation solutions
  • Prepared detailed SOW and assist with new proposal efforts and business development

SR. INTEGRATION SUPPORT – TEAM LEAD

HireRight
11.2021 - 10.2022
  • Provide direct technical support and act as primary lead tech support contact across team’s clients
  • Act as initial technical escalation contact for team members - this involves having deep understanding of each client’s technical/networking environment and key technical processes
  • Provide leadership to and directly manage the team’s resources (team direction, day-to-day guidance, setting team priorities and workflows for the day/week, team processes, coaching & mentoring, etc.)
  • Act as primary liaison and initial point of escalation between team and clients
  • Engage and establish/maintain close collaborative working relationships with appropriate client resources & departments to identify, understand and support technology-related needs and projects in advancement of the client’s mission and goals
  • Facilitate regular tech check-in meetings with direct reports
  • Identify & raise key technology projects/priorities/needs/gaps/issues and work with the other Support teams to ensure the right resources, solution sets & capabilities are brought to bear
  • Responded to customer inquiries and resolved complaints to establish trust and increase satisfaction.
  • Helped streamline repair processes and update procedures for support action consistency.

INTEGRATION MANAGER & LEAD ANALYST

Blue Cross Blue Shield of MA
03.2018 - 10.2021
  • Initiate and collaborate as owner and manage projects to determine the impact when change in various existing platforms/transactions processing
  • Owned EDI 834 & 27x transactions and worked across with various teams to set up and intake new providers
  • Communicate results of analysis and serve as liaison to cross functional business partners at all levels throughout organization, as well as externally to providers
  • Translate business ideas into comprehensive business requirements/ stories and design documents
  • Conduct recurring meetings to review and get updates from the development and QA team
  • Worked with various vendors/clearinghouse such as CHC in developing web portals and APIs
  • Prioritized backlogs and defects resolution based on impact to product quality and production timeline
  • Monitored & resolved EDI transaction processing production issues
  • Provide root cause analysis to the clients
  • Lead and provide guidance, and resource support for other analysts on my team
  • Review various test cases and results based on requirement matrix using
  • Jira
  • Executive level reporting to ensure transparency and highlights to Senior
  • Leaders
  • Presented Risk/ Mitigation options to ensure timeliness in deliverables
  • Maintained flexible schedule and responded to after-hours and weekend emergencies
  • Standardized job tasks and trained junior team members on industry best practices and standards.

PROJECT MANAGER & SENIOR ANALYST

Harvard Pilgrim Health Care
10.2015 - 03.2017
  • Developed, documented and published business data requirements
  • Collaborated with business users, technical teams, database administrators and testing teams during kickoff meetings, joint application designing and planning sessions to validate requirements
  • Oversaw and managed the technical development lifecycle activities associated with delivering a data extract
  • Translated business requirements into Extract Transform Load (ETL) specifications
  • Directed changes to project scope and cost and implemented appropriate change management processes to keep project on track
  • Closely collaborated with project members to identify and quickly address problems
  • Monitored contracts and service level agreements to identify potential risks and implement mitigation actions to protect development process from unforeseen delays and costs
  • Provided technical/engineering support for new and existing applications from code delivery until the retirement of the application
  • Provided both individual and budget-level tasks and product effort estimates/costs.

BUSINESS SYSTEMS & QUALITY ANALYST

Neighborhood Health Plan
01.2015 - 04.2015
  • Identified needed business improvements and determined appropriate systems required to implement solutions
  • Consolidated business rules for system enhancements
  • Analyzed and tested different builds to identify, trace and help resolve bugs
  • Planned and devised cohesive test plans for projects using advanced testing technologies
  • GUI QNxt & PAT systems
  • Documented process flows and developed requirements for functional improvements and enhancements
  • Created Gap analysis document to retire legacy system and develop new
  • GUI systems
  • Created detailed source to data mapping documents for the various user interface
  • Data analysis of various systems
  • Production Support of business areas with ongoing issues, implementations & upgrades
  • Involved in UAT planning strategy, testing and Expertise in Defect Tracking and Bug Reporting
  • Software: Visio, MS Project, MS Office, SQL Server 2012, SharePoint,
  • Trizetto QNXT & HEAT applications.

LEAD BUSINESS SYSTEMS ANALYST

Blue Cross Blue Shield
11.2010 - 08.2013
  • Owned 837 & 835 EDI transactions and oversaw projects that would require changes to the transaction processing
  • Successfully implemented the 4010 to 5010 version per HIpaa compliance and regulatory EDI standards for 837, 835, 834, 820, 270/271, 276/277, 278 transactions
  • Collaborated closely with upper management to drive strategy through development and implementation of new processes
  • Performed system analysis, documentation, testing, implementation and user support for platform transitions
  • Developed flowcharts and diagrams to describe and lay out logical operational steps
  • Gathered requirements and performed gap analysis through design workshops with users
  • Established specifications and coordinated production with software programmers
  • Communicated and explained business requirements to team members to understand and implement functional demands
  • Organized system infrastructure documentation and operating procedures, strengthening controls and enhancing overall performance
  • Performed internal system acceptance to deliver well-tested enhancements and meet business requirements
  • Worked closely with test, development and requirements team members to analyze, investigate and resolve common issues
  • Provided on call
  • Production support
  • Analyzed existing systems and databases and recommended enhancements to solve business needs
  • Reduced processing time by analyzing job schedules and implementing appropriate modifications
  • Provided daily support with escalated ticket resolution and liaised with business and technical leads
  • Troubleshot incidents reported by end-users to schedule system changes and identify permanent solutions
  • Identified and resolved problems through root cause analysis and research
  • Enhanced project management skills by defining and presenting system solutions and timelines for business needs or technical problems.

BUSINESS ANALYST

Crowe Paradis
06.2010 - 09.2010

LEAD ANALYST

EDS – HP Company
09.2008 - 04.2010
  • Worked one-on-one with clients to improve EDI implementation specifications
  • Reviewed contracts and agreements to identify potential risks and ideal mitigation strategies
  • Handled Healthcare claims according to internal risk management policies, keeping liability minimized by leveraging expertise and available tools
  • Kept operations in compliance with state and federal regulations through regular EDI transactions testing
  • Review Validation Plans, Test Plans, Test Summary Reports, Validation
  • Summary Reports
  • Involved in reviewing existing validated documentation and evaluated executed changes controls, reported problems, and vendor upgrades/patches in order to determine if any actions are requires such as upgrading, replacement
  • Lead testing efforts between onsite/offshore teams
  • Core: Visio, Rational Suite (RUP, UML with Rational Rose, Rational
  • Requisite Pro, Rational robot), MS Project.

QA LEAD

Tufts Health Plan
11.2006 - 10.2008
  • Wrote and optimized test cases to maximize success of manual software testing with consistent, thorough approaches
  • Planned and devised cohesive test plans for projects using advanced testing technologies
  • Reviewed project requirements to uncover bugs and vulnerabilities and help maintain project schedule
  • Conducted data review and followed standard practices to find solutions
  • Documented and executed detailed test plans and test cases and summarized and logged audit findings for reporting purposes
  • Documented testing procedures for developers and future testing use
  • Assessed software bugs and compiled findings along with suggested resolutions for development team members
  • Collaborated with QA team to test software quality through manual and automated testing
  • Fixed identified issues to increase productivity and boost workflows
  • Effectively interacted with developer and Analyst regarding software defects and functionality issues, working closely to develop innovative solutions
  • Ensured timely, effective, and quality delivery of software into production, both at individual and team level
  • Tested applications based on business requirements and industry best practices.

Education

Master's - Computer Science/Software Engineering

Governors State University
05.2007

Skills

  • Critical Thinking
  • Conflict Resolution
  • Strategic planning
  • Team Leadership

Additional Information

  • Documented, resolved and owned solution of 277CA acknowledgement generation which led to processing of electronic claims transaction . Achieved balancing of claims processing End to End and validate/balance by introducing a solutions to track the processing between various system interfaces. Extensive knowledge on EDIFECS Transaction manager/SpecBuilder, RDBMS for querying, MS Project for Project plans and tracking progress, MS Office for documenting Requirements/ Visio flow charts etc, Jira for Agile Management, API design knowledge/Postman/Swagger.io for analysis & testing .

Languages

Telugu
Native or Bilingual
Hindi
Native or Bilingual

Will be working Remotely from India

My Family is relocating to India and we are soon to reside in Hyderabad, Telangana. 

I'm willing to work during the US/Global work hours and have done with ease in the past when my stay was longer than expected due to Family emergency.

Timeline

EDI PM Advisor

Gainwell Technologies
11.2022 - 04.2023

SR. INTEGRATION SUPPORT – TEAM LEAD

HireRight
11.2021 - 10.2022

INTEGRATION MANAGER & LEAD ANALYST

Blue Cross Blue Shield of MA
03.2018 - 10.2021

PROJECT MANAGER & SENIOR ANALYST

Harvard Pilgrim Health Care
10.2015 - 03.2017

BUSINESS SYSTEMS & QUALITY ANALYST

Neighborhood Health Plan
01.2015 - 04.2015

LEAD BUSINESS SYSTEMS ANALYST

Blue Cross Blue Shield
11.2010 - 08.2013

BUSINESS ANALYST

Crowe Paradis
06.2010 - 09.2010

LEAD ANALYST

EDS – HP Company
09.2008 - 04.2010

QA LEAD

Tufts Health Plan
11.2006 - 10.2008

Master's - Computer Science/Software Engineering

Governors State University

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Namratha Gillala